Laparoscopic fundoplication versus medical management for gastro‐oesophageal reflux disease (GORD) in adults

Patient or population: Patients with gastro‐oesophageal reflux disease (GORD) in adults
Settings: Secondary care
Intervention: Laparoscopic fundoplication

Control: Medical management

Health‐related quality of life

(< 1 year)

605
(3 studies)

⊕⊝⊝⊝
very low^1,2,3

SMD 0.14 (‐0.02 to 0.3)

(1 to 5 years)

323
(2 studies)

⊕⊝⊝⊝
very low^1,2,4

SMD 0.03 (‐0.19 to 0.24)

GORD‐specific quality of life

(< 1 year)

1160
(4 studies)

⊕⊕⊝⊝
low¹

SMD 0.58 (0.46 to 0.7)

(1 to 5 years)

994
(3 studies)

⊕⊝⊝⊝
very low^1,2,3

SMD 0.28 (‐0.27 to 0.84)

Adverse events

Serious adverse events

RR 1.46
(1.01 to 2.11)

637
(2 studies)

⊕⊝⊝⊝
very low^1,5

Adverse events

RR 13.98
(0.82 to 237.07)

83
(1 study)

⊕⊝⊝⊝
very low^1,3,5,6

Dysphagia

(< 1 year)

RR 3.58
(1.91 to 6.71)

637
(2 studies)

⊕⊝⊝⊝
very low^1,6

(1 to 5 years)

RR 5.36
(2.1 to 13.64)

554
(1 study)

⊕⊝⊝⊝
very low^1,6

(5 years or more)

RR 0.9
(0.57 to 1.42)

228
(1 study)

⊕⊝⊝⊝
very low^1,3,6

Heartburn

(< 1 year)

RR 0.45
(0.3 to 0.69)

554
(1 study)

⊕⊝⊝⊝
very low^1,6

(1 to 5 years)

RR 0.19
(0.1 to 0.34)

554
(1 study)

⊕⊝⊝⊝
very low^1,6

(5 years or more)

RR 0.56
(0.44 to 0.72)

217
(1 study)

⊕⊝⊝⊝
very low^1,6

Reflux

(< 1 year)

RR 0.1
(0.05 to 0.24)

554
(1 study)

⊕⊝⊝⊝
very low^1,6

(1 to 5 years)

RR 0.15
(0.06 to 0.35)

554
(1 study)

⊕⊝⊝⊝
very low^1,6

(5 years or more)

RR 0.69
(0.46 to 1.03)

233
(1 study)

⊕⊝⊝⊝
very low^1,3,6

Long‐term overall health‐related quality of life and long‐term GORD‐specific quality of life were not reported in any of the trials.

*The basis for the assumed risk was the mean control group risk across studies for all outcomes other than adverse events. For control group risk, 1% was used as the control group risk since there were no adverse events in the control group in the only trial that reported this outcome (Anvari 2011). The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.